Department of Molecular Medicine and Surgery, The Karolinska Institute, Stockholm, Sweden.
Ann Thorac Surg. 2011 Oct;92(4):1376-82. doi: 10.1016/j.athoracsur.2011.05.011. Epub 2011 Aug 19.
Intraoperative and in-hospital mortality after surgery for acute type A dissection depends largely on preoperative conditions, specifically the presence of localized or generalized ischemia. Recently, the Penn classification of patients with acute type A aortic dissection has been described. The primary aim was to validate the Penn classification and to investigate preoperative variables related to mortality.
All consecutive patients operated for acute type A aortic dissection, 1990 to 2009 (n = 360), were included in a retrospective observational study. Univariate and multivariable analyses were used to identify variables related to intraoperative and in-hospital mortality. Propensity scoring was used to adjust for treatment selection bias.
Overall intraoperative mortality was 7% (24 of 360) and in-hospital mortality was 19% (69 of 360). Two hundred nineteen patients (61%) were Penn class Aa (14% in-hospital mortality), 51 (14%) class Ab (24% mortality), 63 (18%) class Ac (24% mortality), and 27 (8%) class Abc (44% mortality), p =0.007. In multivariable analysis, Penn class Ac and Abc were independently related to intraoperative death (odds ratio 5.0 and 5.4, respectively), and Penn class Abc and non-Aa were independently related to in-hospital mortality (odds ratio 3.4 and 2.3, respectively). Concomitant coronary artery bypass grafting, older age, DeBakey type I dissection, and prolonged periods of cardiopulmonary bypass and hypothermic circulatory arrest were also independently associated with mortality.
The Penn classification of acute type A aortic dissection is purposeful and its continued usage encouraged. Penn class indicating localized or generalized ischemia is independently related to intraoperative and in-hospital mortality.
急性 A 型主动脉夹层手术后的术中及院内死亡率在很大程度上取决于术前情况，特别是局部或广泛缺血的存在。最近，已经描述了急性 A 型主动脉夹层患者的 Penn 分类。主要目的是验证 Penn 分类，并研究与死亡率相关的术前变量。
回顾性观察研究纳入了 1990 年至 2009 年期间接受急性 A 型主动脉夹层手术的所有连续患者（n=360）。使用单变量和多变量分析来确定与术中及院内死亡率相关的变量。采用倾向评分法调整治疗选择偏倚。
总体术中死亡率为 7%（24/360），院内死亡率为 19%（69/360）。219 名患者（61%）为 Penn 分类 Aa（14%院内死亡率），51 名（14%死亡率）为 Ab 类，63 名（18%死亡率）为 Ac 类，27 名（8%死亡率）为 Abc 类，p=0.007。多变量分析显示，Penn 分类 Ac 和 Abc 与术中死亡独立相关（比值比分别为 5.0 和 5.4），而 Penn 分类 Abc 和非-Aa 与院内死亡率独立相关（比值比分别为 3.4 和 2.3）。同时行冠状动脉旁路移植术、年龄较大、DeBakey Ⅰ型夹层和体外循环及低温循环阻断时间延长也是死亡的独立相关因素。
急性 A 型主动脉夹层的 Penn 分类是有意义的，应继续使用。提示局部或广泛缺血的 Penn 分类与术中及院内死亡率独立相关。
